Should Doctors and Patients Be Facebook Friends?

Physicians are navigating some tricky challenges as they enter the world of social media. WSJ's Anna Mathews and Dr. Saroj Misra join Lunch Break to discuss. Photo: Getty Images.

By

Anna Wilde Mathews

Feb. 4, 2013 6:40 p.m. ET

When Kenda Ross's husband, Robert, has an excruciating arthritis flare-up or other urgent health issue, she typically calls the office of his doctor, Jen Brull. If she can't get Dr. Brull by phone, she sometimes tries another way—Facebook.

Dr. Brull gets the messages on her smartphone and usually calls back quickly with advice. Once, when Mr. Ross's knee was red and swollen after a shot and Dr. Brull was traveling, she urged a visit to an urgent-care clinic to check for infection. "I know she's available, no matter where she is," says Ms. Ross, a 64-year-old retiree in Plainville, Kan.

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As social-media tools become ubiquitous, doctors are finding a role for them in their medical practices. But Facebook, Twitter and other social media bring challenges and worries, as well as opportunities. Among the concerns: protecting patient privacy and maintaining appropriate boundaries between professional and social relationships.

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Gerry Tolbert, a family physician in Florence, Ky., uses Twitter to communicate health messages, and occasionally some personal interests—like "Star Wars"—will surface. He likes relaying useful information broadly to patients and others, he says. But he never tweets about individual patients, not even anonymously, he says. "It's not my place to decide who gets to hear their personal story."

According to a survey published in 2011 in the Journal of General Internal Medicine, 94% of medical students, 79% of residents and 42% of practicing physicians reported some use of online social networks, nearly all for personal reasons. Among the practicing physicians, 35% said they had received a "friend" request from a patient or family member—and 58% of those who had received those "friend" requests said they always rejected them.

A survey of physicians last May by Epocrates inc., which develops medical reference apps for physicians, found that 82% were using social networks to engage with other physicians, while just 8% were doing so with patients.

Saroj Misra, a Warren, Mich., family physician, saw a patient with a fracture last year and used Doximity, an online professional physician network, to send a question to a medical-school classmate who is an orthopedic surgeon. His friend suggested a certain type of splint and urged that the patient follow up with a local orthopedic surgeon. It took just "a few minutes" to get the advice via his smartphone, Dr. Misra says. "That is awesome."

Jake Varghese, a Cumming, Ga., family physician, communicates with patients digitally, using a portal and other tools provided by his employer, the Kaiser Permanente system. But he said he wouldn't feel comfortable "friending" a patient through his personal Facebook page. "It crosses a line" from a professional to a personal relationship, he says. "If I'm talking to them about their blood pressure, and they say, 'You went out to eat at so-and-so last week, should you be doing that, Doc?'—it takes a bit from that objectivity."

Dr. Brull, the Kansas family physician, says in her small-town practice she inevitably has social contact with many patients, and she's comfortable with having those who are her friends offline also becoming Facebook friends and seeing updates about her family and professional life. Plus, it's an easy way for certain patients to reach her, she says. "It fits the way I like to practice," she says. Like other doctors, though, she says she won't send answers to health questions via social media for privacy reasons.

Mark Ryan, a Richmond, Va., family physician, doesn't mind if patients follow his Twitter feed, which sometimes reflects his views on political issues related to health care. He wouldn't spontaneously bring up his policy opinions in the exam room, he says, but if patients choose to seek him out on Twitter, it is their choice. "They may or may not agree with it, but at the end of the day, I don't think they could point to anything and say it was unprofessional," he says. "Physicians need to be actively involved in our communities."

The American Medical Association's Council on Ethical and Judicial Affairs published guidelines in 2011 suggesting doctors need to "maintain appropriate boundaries of the patient-physician relationship" online and to consider separating professional and personal content online.

Some doctors say they connect with patients in ways that are completely separate from their own personal lives, and they sometimes see benefits. Pamila Brar, who practices in La Jolla, Calif., focuses on health advice and information in her tweets and on her Facebook page. Sometimes she learns something useful about her patients. One patient mentioned in a Facebook post that he was waking up a lot at night to use the bathroom, which he hadn't shared with Dr. Brar at his physical exam. Dr. Brar followed up by phone and eventually prescribed treatment.

Wanda Filer, a York, Pa., family doctor, connects with some patients via LinkedIn, and she tweets to followers who include many fellow doctors. Her Facebook page is dedicated to health topics, and she doesn't post personal information. Still, she once learned via a LinkedIn update that a patient had been in the hospital. "I gave her a call and said, 'Maybe we should make an appointment,' " Dr. Filer says. "It was fortuitous."

Social-media issues are getting more attention from medical schools, which are starting to teach about social-media standards and regulators. A survey of state medical board officials published last month in the Annals of Internal Medicine highlighted several hypothetical situations they might target. Of most concern were physicians who posted misleading information about clinical outcomes, misrepresented credentials, used patient images without consent or contacted patients inappropriately—the same kinds of behavior that typically draw scrutiny offline, said S. Ryan Greysen, lead author of the study and assistant professor at the University of California, San Francisco. The article said several scenarios were based at least partly on actual incidents.

The Rhode Island Board of Medical Licensure and Discipline in 2011 reprimanded an emergency-room physician who posted about her clinical experiences on Facebook. Though she didn't identify patients by name, readers were able to identify one of them because of the nature of the injury. "There's no business for protected patient information on Facebook, period, the end," said James McDonald, chief administrative officer for the Rhode Island board. "Social media isn't meant to be the exam room." The physician didn't return a call seeking comment.

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